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General NPI Number Information
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NPI Number | 1871787572
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Entity Type | Organization
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Legal Business Name | CROSSROADS LIVING CENTER INC.
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 1250 WOODMAN WAY
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City | DIXON
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State | CA
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Zip | 95620-2142
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Country | US
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Telephone | 707-678-1802
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Fax |
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Provider Business Mailing Address
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Address Line | 320 CERNON ST
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City | VACAVILLE
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State | CA
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Zip | 95688-4502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIE SCHUDER
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Credential |
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Telephone | 530-632-3043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State | CA
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